Table 4.

Facilitators and inhibitors in pandemic management identified: Ebola

Political (P)	Economic (Econ)	Sociological (S)	Technological (T)	Ecological (E)	Legislative (L)	Industry (I)
Ebola:
Facilitators
Political commitment contributed to a rapid/effective response in some countries (eg, Nigeria) (West Africa) [24]	Countries with trading partners are more likely to act early to protect trade and prevent contagion; securing important inputs for domestic industries or output markets motivate HCW deployment abroad (West Africa) [27]	Hand shaking discouraged by the federal government; HCWs and non-clinical staff in hospitals demanding full PPE before consulting any patient; high public awareness and interest; trust and confidence in public authorities enhancing adoption of recommended containment measures (Nigeria) [26]			Temporary border closure (eg, Cameroon and Chad) (Nigeria) [26]
Declaration of national emergency (eg, Nigeria); demonstration of political commitment (eg, Presidential Summit attended by Minister of Health, State Governors and their Commissioners in Nigeria); national weekly briefings to provide up-to-date information, and dispel fears, rumours and misconceptions (Nigeria) [26]
Deployment of foreign HCWs, as aids from allies, maintain global balance of political power; historical choices and policies facilitate institutionalised capacities and norms for civil emergency management, foreign medical aid, or overseas military personnel deployments (West Africa) [27]		Media coverage and public attention facilitate humanitarian assistance and HCW deployment (West Africa) [27]
Inhibitors
Political interference (eg, contact tracer recruitment and organisation led by non-health institutes) (Sierra Leone) (23)	Poor health care system financing (West Africa) [24]	Inadequate self-prescribed infection preventative measures due to poor health education; poor housing conditions in rural areas; poor safety orientation (training) in hospitals; low adherence to government regulations in rural areas despite public campaigns; re-infection due to risky sexual behaviours; lack of follow-up with recovered cases and long-term monitoring; culture and tradition (eg, mass gathering at funerals) (West Africa) [24]	Incomplete case monitoring database (Sierra Leone) [25]	High prevalence of nosocomial infections; climate conditions increasing transmission; deforestation; physical proximity between human and wildlife, including animal reservoirs (eg, fruit bats); zoonotic pathogens transmitting across species; low vaccination due to misinformation in mass media (West Africa) [24]	Cross-border transmission due to relaxed immigration policies (West Africa) [24]	Inadequate drug and PPE supply; staffing limitation due to transmission among HCWs (West Africa) [24]
Contests between powerful domestic actors delaying crisis response; organisational limitations, cognitive barriers and political construction of threat perception in policy makers may lead to hesitation in HCW deployment (West Africa) [27]		Rejecting contact tracing due to stigma and fear, and/or to avoid quarantine; inadequate training of contact tracers; lack of support to quarantined citizens (Sierra Leone) [25]				Lack of appropriate equipment for contact tracers; heavy workload due to shortage of contact tracers (Sierra Leone) [25]
		Stigma and discrimination against patients and HCWs who treated them and subsequent actions (eg, protests near treatment centres due to lack of knowledge, fear, and misinformation on mass media (eg, Ebola infection is incurable); low willingness among HCWs to join the front line due to fear; low confidence in the capacity of health system and leadership to provide reliable information and resources for infection prevention (Nigeria) [26]				Deployment of HCWs can be delayed if industry interdependence exists, such as logistical planning, medical evacuation, and other necessities (West Africa) [27]